Benchmarking outcomes in maternity care: peripartum incontinence - A framework for standardised reporting

Abstract

Objective : To evaluate a framework to facilitate standardised reporting of perinatal incontinence.

Design : An exploratory, prospective, observational cohort study.

Setting : One Australian tertiary maternity referral centre.

Participants : Data from 309 pregnant women collected between August 2017 and January 2019.

Measurements and findings : A framework was developed using consensus-based terminology and definitions, measures and data-collection time-points. The ICIQ-UI SF and the Wexner Scale were administered during pregnancy (<27 and 36-weeks) and postpartum (6- and 26-weeks). Incidence, trajectory and group differences for urinary incontinence subcategories were evaluated. Stress urinary incontinence was the largest contributor of urinary incontinence during pregnancy (39.2%) followed by mixed (11.3%) and urgency incontinence (7.4%). Factors associated with incontinence subcategories during pregnancy were multiparity (stress: RR 1.74), co-existing anal incontinence (mixed: RR 3.51) and early pregnancy urinary incontinence (stress: RR 2.79; mixed: RR 2.85). Factors postpartum included primiparity (urgency), vaginal birth (stress), induction of labour (stress: RR 2.99; urgency: RR 0.2), waterbirth (urgency: RR 2.66), coexisting anal incontinence (urgency: RR 3.55) and late pregnancy urinary incontinence (mixed: RR 3.97). Low numbers of women with anal incontinence prohibited subcategory analysis.

Key conclusions : Findings offer preliminary support for the effectiveness of the framework for the measurement and reporting of urinary incontinence in childbearing women. Future research is needed to evaluate the framework in larger and more diverse maternity populations.

Implications for practice : A framework for standardised measurement and reporting of perinatal incontinence will facilitate improved synthesis of research findings with the potential to improve the quality of evidence-based clinical guidelines.